Applicant:
Name: _________________________________________________
Mailing Address: __________________________________________
__________________________________________
City, State ZIP: __________________________________________
Telephone Number: (_____) ____________________
Date of Birth: _______________
Soc. Sec. No. _______________
Service:
Date of entry: ___________________
Date of discharge: ________________
Service Branch: _________
Service No. _______________
Signature: ______________________________ Date: ____________________
Print out the form on your printer, fill it out and send or bring the completed form with dues of $25.00 and your DD-214 or other official records to verify your service to:
Bourque-Lanigan Post #5
American Legion
Attn: 1st Vice Commander
PO Box 41
Waterville, ME 04903-0041
Tel:(207) 872-8824